WASHINGTON — Citing "severe deficiencies" in medical care, the federal government threatened Thursday to shut off federal funding for a state-administered program serving 35,000 mentally retarded and developmentally disabled California residents.
In a bluntly worded decree, the Health Care Financing Administration said its investigators have determined that the "health and welfare" of participants in California's Home and Community-Based Service program are clearly "at risk."
The order bars new admissions to the program, which provides services through 21 regional centers that subcontract with group and nursing home operators and other providers. The program functions under a waiver granted by Washington aimed at helping move people out of state hospitals.
At least 20,000 of the people served by the program are in Southern California.
State officials must respond to the federal government's findings and propose remedies within 30 days. The state has until June to overhaul the program to Washington's satisfaction.
"Some enrollees' health and ability to function are markedly declining, [and] mortality rates are of concern," HCFA said in announcing the action. "Many centers operating under the waiver are unsanitary, lack appropriate supervision, fail to provide adequate nutrition and employ staff who lack skills and training necessary to serve this population."
HCFA, a branch of the Department of Health and Human Services, says program providers are also over-medicating some participants and denying them their right to choose whether to live in community settings or in institutions.
Residents of the regional centers and group homes are considered severely impaired, and many require help with washing, eating and other daily activities. HCFA said they are not getting adequate assistance.
Although some residents should not be allowed to move about without supervision, federal officials said a number of people needing supervision were either missing or receiving little attention when investigators visited the centers.
"California has the largest waiver program," said HCFA Administrator Nancy-Ann Min DeParle. "We would not have [issued Thursday's decree] if we had not been very concerned about the seriousness of the situation."
California officials have not yet scheduled a meeting with Min DeParle. Officials in Gov. Pete Wilson's administration insisted that they already are taking corrective action in the $500-million-a-year program, and do not expect to lose the $250 million a year that the state receives from the federal agency.
"We won't lose [the money]," said Tim Comstock, spokesman for the California Health and Welfare Agency, which oversees the care of the state's developmentally disabled people. "We've already taken a number of corrective actions. We will fully comply with the recommendations. I have absolutely no fear that we're going to lose any of this money. It's not even thinkable."
California's care of the severely mentally retarded has come under repeated fire as the state has tried to empty hospitals where many such people had received care for decades.
The state shuttered Camarillo State Hospital earlier this year, forcing the release of 450 mentally retarded people. Some were placed in other state hospitals; others went to group homes where care costs far less.
About 3,800 developmentally disabled people were housed in state hospitals this summer, down from 6,700 in 1991. The state planned to move 500 more people out by next summer. But the transfers were halted in the wake of reports of serious problems with the care of some who had been moved.
The state has made the moves partly out of a desire to save money, but also in response to a suit settled in 1993 by parents of some developmentally disabled people who demanded that their children be cared for in community settings.
Many people being moved, however, have no family members with legal standing to argue on their behalf, say critics of the state policy.
The state's $1.6-billion-a-year Department of Developmental Services oversees the 21 regional centers.
Federal officials said no program participants will be turned out of their current residences without someplace to go. California has hundreds of group homes scattered across the state, ranging in size from four beds to as many as 60.
Indeed, federal officials said one reason for giving the state six months to improve the program is to ensure time for an orderly transition if enrollees need to be moved to new facilities.
"That's a bombshell," professor David Strauss, of UC Riverside, said of Thursday's action.
Strauss, among the sharpest critics of the state's policy, has been studying deaths of severely mentally retarded people who have been released from state hospitals and placed in group homes in California.